This is a practical nuts-and-bolts guide that is based on the authors’ experience and success in the Radiology Department at the University of California at San Francisco. Academic chairs, especially those recently appointed, struggle with leadership and management. Many have little prior experience in these areas. The material presented here is practical and specific. Each chapter is independent of the others, and the text can be used mostly as a reference tool. The text deals with the major issues facing academic Radiology leaders. The topics selected were chosen carefully and are based on the authors’ collective years of experience attempting to manage their own department but also consult for many others. The first topic is the balance among the three primary missions of an academic department, namely, clinical care, teaching, and research. These three major missions will be described in some depth, with an effort to provide reference materials that, hopefully, will stand the test of time and remain useful over the years to come. In addition, this text will provide guidance about faculty development, departmental organization, marketing and fundraising, and strategic perspectives. It will be of interest to chairs, departmental administrators, vice-chairs and other departmental leaders, section chiefs, hospital administrators and, of course, consultants.